Dosage prediction of chloroquine and ritonavir-boosted lopinavir for
COVID-19 treatment: A physiologically-based pharmacokinetic (PBPK)
modelling
Abstract
Abstract Background and Purpose: The 2019 novel coronavirus (COVID-19)
has been spread out since December 2019 from China to 29 countries. No
effective treatment is currently available, although the combination
regimen of the antiretroviral drugs– lopinavir/ritonavir (LPV/r), with
other antiviral drugs have been using, but the evidences are limited. A
recent in vitro study showed that chloroquine could inhibit COVID-19 to
cells, and enhance antiviral efficacy. This study aimed to predict the
optimal dose regimens of LPV/r, and chloroquine in combination as a
potential treatment of COVID-19 infection, using the
physiologically-based pharmacokinetic (PBPK) modelling. Experimental
approach: The whole PBPK models were constructed. The predicted plasma
drug concentrations were compared with the published clinical data. The
validated models were used to predict optimal dosage regimens of LPV/r,
and chloroquine co-administration. The optimal dose regimen was
determined based on the efficacy, and toxicity reported in the published
data. Key Results: The average errors of the predicted values were
within 30% of the observed data. The proposed optimal dosage regimen is
the once-daily dose of 800/200 mg LPV/r co-administered with chloroquine
at a loading dose of 1,000 mg, followed by twice-daily dose of 500 mg
for 8 doses on the second day, and the twice-daily dose of 400 mg for 18
doses. Conclusion and Implications: PBPK modelling successfully
predicted pharmacokinetic profiles within an acceptable range of errors.
The study provides a focus for clinical studies to confirm the efficacy
of the proposed dosage regimen as a novel treatment for COVID-19
infection.